TMD

Temporomandibular Disorders

Temporomandibular Disorders (TMD), also known as Craniomandibular Dysfunctions (CMD), is an overarching term for various symptoms, dysfunctions, and pathological changes in the jaw joints and muscles of mastication, as well as the anatomically and functionally associated structures in the mouth, head, and cervical spine.

We can differentiate between structural degenerative changes, malfunctions, and/or pain in the area of the grinding surfaces of the teeth (a so-called occlusopathy or occlusion disorder), of the chewing muscles (myopathy), or the jaw joint (arthropathy).

There are always multiple reasons and several factors involved in the development of temporomandibular disorders. A distinction is made between occlusal factors in which there is a disturbance of the bite conditions (due to tooth and jaw misalignments, tooth extractions or fillings, dental crowns or bridges, etc.), neuro-muscular factors in which there is a dysfunction between nerves and muscles (such as tooth clenching or bruxism, chewing gum, cheek and lip biting, lack of coordination in combination with a bad posture of the cervical spine), and psychosocial factors, e.g. negative stress, perfectionism, anxiety, depression, traumatic life events (divorce, death, unemployment), etc.

Dysfunctions &  Symptoms.

Frequently, craniomandibular dysfunctions have various symptoms such as jaw joint pain, pain in the mastication muscles, reduced jaw joint mobility, disturbances of mouth opening/closing, jaw joint noises such as clicking or crunching, radiating pain in regions such as the teeth, mouth, face, head, shoulders or cervical spine.

Besides, impairments and limitations of mobility in the areas of the cervical spine, thoracic spine, or shoulder joints may occur as well. Accompanying symptoms can also include ear pain, tinnitus, headache, facial pain, dizziness, vision problems, or swallowing disturbances.

Interdisciplinary working

The complexity of temporomandibular disorders, with their multicausal origins and diverse symptoms, often makes it inevitable for the patient to undergo multidisciplinary diagnostics and therapies. Physiotherapy and the role of the physiotherapist as a specialist in the movement system, which includes the jaw joint, take on a central role in close cooperation and communication with the dentist in the treatment of craniomandibular dysfunctions.

The physiotherapist first performs an accurate functional diagnosis and, depending on the findings, applies therapeutic techniques such as specific mobilizations of the jaw joint and its associated structures such as the capsule, disc, muscles, and/or nerves, which are supplemented by a specific exercise program and aim to strengthen and stabilize, as well as to improve the coordination and mobility of the temporomandibular joint and all of the anatomical structures connected to it (facial and chewing muscles, neck and shoulder region). It is the patients' responsibility to continue performing all of the instructed therapeutic exercises by himself or herself at home to get the best results.